GENERAL REPORT.

This, the fourth annual report of the State Board of Health, is for the year ended October 31, 1889.

PERSONNEL OF THE BOARD.

The term of office of Dr. John D. Jones having expired December 13, 1888, he was re-appointed for the full term of seven years.

Subsequently Dr. Jones tendered his resignation as a member of the Board, having been called to Europe, where he expected to remain for some time.

His resignation was accepted, and Dr. Joseph L. Anderson was appointed to fill the vacancy thus created.

The names and addresses of the Board are now as follows:

We take pleasure in reporting that no wide-spread epidemics have prevailed in our State during the year, and that reports from physicians and local boards of health indicate that the general health as not been

below the average.

Through the local boards of health a gradually perfected system of weekly reports of preventable diseases is being completed, so that by another year we may hope to present comparatively accurate statistics of the prevalence of such diseases among urban populations.

Small-pox.-As was foreshadowed in our last report, small-pox made its appearance in our State and was the cause of considerable alarm and some interruption of business.

The wisdom of the Board in providing for the weekly receipt of fresh vaccine virus was made manifest by the numerous demands for it; and there can be little doubt, but for the prompt action of the Board in sending virus and proper instructions to points where the disease had broken out, and also in personally directing quarantine and disinfection in several instances, the disease would have prevailed in Ohio to considerable extent.

As it was, while there were fourteen outbreaks of small-pox in the State, and twelve of them entirely disconnected one with the other, only forty-six cases of the disease occurred. This gives an average of three and one-seventh cases to each outbreak; but if we eliminate sixteen cases which occurred at Porter, where the disease was so mild that its nature was not recognized until many had been exposed, the average number of cases per outbreak is reduced to two and one-third.

An outbreak of small-pox always occasions more or less financial loss to the State on account of the panic and consequent interruption of business.

At the recent outbreak near New Washington, Crawford county, although there was not a case of small-pox within two miles of the village, it was almost entirely cut off from the outside world by a most senseless and useless quarantine. Even the mail was refused for a short time.

The State Board, upon investigation, promptly removed all restrictions to travel and commerce, and by an authoritative statement as to the actual conditions there, quieted the unwarranted excitement existing in that part of the State.

The experience at New Washington, and to a larger extent the experience of Southern States during the last epidemic of yellow-fever in Florida, points to the necessity of vesting in some central body the power to regulate and adjust matters relating to quarantine.

We are pleased to report that the Ohio State Board of Health, by an act of the last General Assembly, has been granted full power to enforce and regulate quarantine measures, and hereafter interruptions to commerce shall be the least possible consistent with necessary precautions to prevent the spread of epidemic diseases.

The appearance of small-pox in our State was not wholly without benefit, for by notifying local boards of health and boards of education of the fact, and by urging them to act conjointly in securing the vaccination of school children, many thousands of unprotected persons were vaccinated who would not have been but for the fear of an epidemic.

Reports of the several outbreaks of small-pox in Ohio during the last fiscal year are given in detail on another page, and they point to the

certain ability of local boards of health to control and confine a highly contagious disease when supported by the authority of public opinion.

Typhoid-Fever.-This disease is never absent from our State, and is common alike to urban and rural districts.

It is most frequently due to the use of polluted water, and could be prevented to a very great extent.

The substitution of a pure for an impure water supply in a number of cities where observations were made, was almost invariably followed by a very material reduction in the death rate of typhoid fever.

We are pleased to note that a number of local boards of health are waging a successful war against that abomination and constant source of danger the common hole-in-the-ground privy. Again and again has typhoid-fever been traced to using water from a well polluted with leachings from a neighboring privy-vault, and the enforcement in towns not provided with a public water supply, of the rule recommended by the State Board, that no privy-vault, unless absolutely water-tight, shall be permitted within fifty feet of any well or other source of water-supply, will, undoubtedly, diminish the number of cases of typhoid-fever and other diseases attributable to impure drinking-water. We showed by answers from physicians, published in our last report, that it is by no means uncommon for the undisinfected discharges of a typhoid-fever patient to be thrown into privy-vaults or upon the ground; and that where disinfection is attempted copperas or some equally inefficient agent is frequently used.

Dr. Bartholow, of Philadelphia, in a recent article on Preventive Causes of Typhoid-Fever, says: "It is a subject worthy of the deepest consideration by all legislators hether the time has not arrived for imposing severe penalties on those who permit the escape of typhoid germs and spores from fever cases." (The italics are his).

The thousands of pamphlets upon the prevention of typhoid-fever, and those on disinfection and disinfectants, which the Board has distributed, will, it is hoped, prove of material benefit, by enlightening the public in regard to the care of this disease.

DIPHTHERIA, SCARLET-FEVER, WHOOPING-COUGH AND MEASLES.

These common and fatal diseases of childhood prevailed to some extent during the entire year.

Our weekly reports from correspondents, though including the practice of not more than two per cent. of the physicians of the entire State,

report 3,241 cases of these four diseases, and in no week was an entire absence of any one of them noted, except measles.

Local epidemics of diphtheria have prevailed at several places, notably severe at Middletown, Moscow and Washingtonville.

In the former place, with a population of 8,000, over 400 cases and fifty-five deaths occurred from this disease; while in Moscow, with about 600 inhabitants, 89 cases and 13 deaths occurred.

A full report of the Middletown epidemic by Dr. Sutphen, health officer, and a report of the Moscow epidemic, by the Secretary, are published in another part of this report.

Diphtheria has long been classed among the "filth diseases;" but common observation shows it to occur in houses where the greatest cleanliness prevails; and, when the disease is once introduced into a town, it is by no means usually confined to its filthy quarters.

It will be well to correct this opinion of the dependence or even constant association of filth and diphtheria. It is now pretty certain that this disease is usually communicated by personal intercourse, and its prevention can be most surely accomplished by rigidly separating the sick from the well, and by the careful disinfection of infected houses, clothing, etc.

Both of these provisions are constantly disregarded even in cities having well organized health departments.

It can hardly be expected that the attending physician will oversee the disinfection required in cases of contagious diseases.

In the majority of cases he gives instructions as to how it should be done, but frequently these are not observed Some neglect disinfection on account of the expense, and many more on account of ignorance and carelessness.

Local boards of health should not be satisfied with simply placing a card on the house announcing "Diphtheria within," but should see that the patient is properly isolated, and should superintend, or better, should send a properly instructed man, who should himself thoroughly disinfect the house and all infected articles. This action upon the part of local boards of health was evidently contemplated in the laws for their government, for section 2135 of the Revised Statutes reads: The Board of Health may take measures and supply agents and afford inducements and facilities for gratuitous, vaccination and disinfection.

In our larger cities it might be wise to erect a central disinfectant station with safe means for conveying infected household goods to this station.

In some European cities portable disinfecting apparatus are used, which are taken directly to the house containing a case of infectious disease.

While boards of health, by contending for pure water, better drainage and clean, healthy homes, can do much in preventing disease, we feel that the pressing need of the hour is the restriction of contagious and infectious diseases.

For this purpose boards of health should be given absolute power. Infectious disease hospitals should be erected, where all cases should be taken when proper isolation can not be secured at home. Waiting that time, boards of health can still do much, by judiciously exercising the powers already granted them. The State Board has placed in the hands of local boards, pamphlets treating of the restriction of infectious diseases, with instructions to place a copy in each house in which such disease is reported, and also in the neighboring houses. Communities having boards of health are being, in this way, instructed in regard to the prevention of contagious diseases.

Scarlet fever has prevailed only to a limited extent. An outbreak of scarlet-fever occurred at Monett Hall, Delaware, a building inhabited by female students of the Ohio Wesleyan University. The disease commencing to spread, school was dismissed, four patients remaining confined in an annexed building.

The State Board was requested to advise as to the best methods of disinfection. The Secretary visited the building and gave directions for a thorough disinfection, including cleaning and aeration of the building.

School was resumed in a few weeks, and although three or four cases subsequently developed, they were shown to have been contracted outside the building-a number of cases existing in the town of Delaware at the time.

MEETINGS OF THE BOARD.

Four regular meetings of the Board were held during the year-one in Columbus, one in Delaware, one in Sandusky, and one in Springfield.

For the purpose of educating the people to the benefits of a proper observance of sanitary laws, and to enlist their sympathy in the work of the State and local boards of health, it was determined, at the January meeting of the Board, to hold at least two meetings annually at places other than Columbus, and in connection therewith, to arrange for one or more public sessions, at which papers and addresses relating to sanitary